Association of preserved ratio impaired spirometry and restrictive spirometric pattern with incident atrial fibrillation: a cohort study

Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of atrial fibrillation (AF). To our knowledge, no studies have examined the association of preserved ratio impaired spirometry (PRISm) or restrictive spirometric pattern (RSP) with incident AF. We included participants without prevalent AF who had incident AF ascertainment and available spirometry and excluded those with airflow limitation. PRISm and RSP were evaluated as binary exposures and as four mutually exclusive spirometric patterns. Missing covariates were handled using multiple imputation by chained equations, and logistic regression estimates were pooled using Rubin’s rules. Sensitivity analyses used an individual lower limit of normal (LLN) for the forced expiratory volume in 1 s (FEV 1 )/forced vital capacity (FVC) ratio, complete-case analysis, and an alternative smoking model including pack-years and current smoking. A total of 2219 participants were included, with a mean age of 62.4 years, of whom 43.6% were male. During follow-up, 247 incident AF events (11.1%) were recorded. In fully adjusted models, PRISm was associated with incident AF (adjusted odds ratio [aOR] = 2.12, 95% confidence interval [CI] 1.35–3.31, P = 0.001), and RSP was also associated with incident AF (aOR = 2.38, 95% CI 1.58–3.60, P < 0.001). When participants were categorized into four mutually exclusive groups, PRISm+RSP remained associated with incident AF (aOR = 2.62, 95% CI 1.63–4.22, P < 0.001), whereas PRISm alone (aOR = 0.77, 95% CI 0.21–2.81, P = 0.690) and RSP alone (aOR = 1.88, 95% CI 0.93–3.80, P = 0.077) were not statistically significant. Results were consistent in sensitivity analyses. Among adults without airflow limitation, binary PRISm and RSP were associated with higher odds of incident AF. In mutually exclusive analyses, the clearest association was observed in participants with concurrent reductions in FEV 1 and FVC.